Improving Trauma Outcomes:A Patient Centered Approach

尽管在过去二十年中在组织和交付方面有了很大的改进 在创伤护理方面，严重创伤往往会导致适龄工作人员的长期功能状况不佳。 一些研究已经强调了单独治疗的局限性，并证明了更大的 只有通过同时解决心理社会问题的干预措施，才有可能改善结果 并协助患者自我管理其受伤的多因素后果。 干预：正是在这种背景下，美国创伤协会发展了创伤幸存者网络 (TSN)计划，以患者为中心的干预措施，旨在填补护理和康复方面的关键空白 创伤幸存者。TSN计划由四个组成部分组成--医疗保健提供者培训、 高效获取信息和推荐、同伴支持计划和与自我管理课程相关的课程 通过定制的信息技术应用程序。目标：本研究的目的是 以评估TSN。我们将：(1)确定通过以下方式提供的服务的使用情况和满意度 TSN计划；以及(2)评估TSN计划在改善小学、中学 以及创伤患者的中间结果。研究设计和参与者：前瞻性临床试验 将使用前测-后测滞后对照设计来评估TSN。共有324名患者入选 在两个I级创伤中心实施TSN之前。这些人将作为控制者 并在伤后9个月评估其预后。在两个地点实施TSN后 在创伤中心，将登记540名患者的第二个队列，并在受伤后9个月进行跟踪。这些 个人将作为干预组。结果：有效性的主要衡量标准将包括： 自我报告疼痛、焦虑、创伤后应激障碍、抑郁情绪和积极情绪。次要结果衡量标准 包括：功能、回归平时的主要活动和生活质量。主要和次要方面的改进 结果将通过干预对自我效能感、患者积极性和知识的影响而产生， 灾难和社会支持。如果被证明是有效的，TSN将提供额外的关键 目前在全国各地的创伤中心提供的护理组件，并确保全面 以患者为中心的创伤管理，以改善长期结果和生活质量。

Despite substantial improvements over the last two decadesin the organization and delivery of trauma care, severe injuries often result in poor longterm functional outcomes for working age individuals. Several studies have highlighted the limits of medical treatment alone and demonstrated that larger improvements in outcome will only be possible through interventions that also address the psychosocial needs of patients and assist them in self-managing the multi-factorial consequences of their injury. Intervention: It is in this context that the American Trauma Society developed the Trauma Survivor's Network (TSN) Program, a patient centered intervention designed to fill critical gaps in the care and rehabilitation of trauma survivors. The TSN program consists of four integrated components - health care provider training, efficient access to information and referral, a peer support program, and a self management course - linked together through a customized Information Technology application. Objectives: The purpose of this study is to evaluate the TSN. We will: (1) determine the use and satisfaction with services made available through the TSN Program; and (2) evaluate the effectiveness of the TSN Program in improving primary, secondary and intermediary outcomes for trauma patients. Study Design and Participants: The prospective clinical trial will use a pretest-posttest lagged-control design to evaluate the TSN. A total of 324 patients will be enrolled prior to implementation of the TSN at two Level I trauma centers. These individuals will serve as the control groupand their outcomes assessed at 9 months post-injury. Following implementation of the TSN at both trauma centers, a second cohort of 540 patients will be enrolled and followed at 9 months post-injury. These individuals will serve as the intervention group. Outcomes: Primary measures of effectiveness will include: self-reported pain, anxiety, PTSD, depressed mood, and positive mood. Secondary outcome measures include: function, return to usual major activity and quality of life. Improvements in primary and secondary outcomes will result through the impact of the intervention on self efficacy, patient activation and knowledge, catastrophizing and social support. If shown to be effective, the TSN will provide an additional critical component to the care now available in trauma centers throughout the country and ensure comprehensive patient centered trauma management to improve long-term outcomes and quality of life.